Post Magazine: The Peace Drug

After decades of wariness about hallucinogenic drugs, researchers arenow measuring the therapeutic effects of MDMA, or ecstasy, in a federalclinical study. In this week's issue of Washington Post Magazine, Tom Shroder explores the drug's scientific potential in treating post-traumatic stress disorder.

Tom Shroder is the editor of the Magazine. He can be reached atshrodert@washpost.com.

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Tom Shroder: Thanks for joining the chat today. I'll answer as many questions as I can.

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Washington, D.C.: How do advocates like Rick Doblin propose to completely remove the possibility of the diversion of psychedelic drugs in the future prescription regime they advocate?

Tom Shroder:"Completely removing the possibility of diversion" is a pretty tough standard, one that is obviously unmet for any currently approved medical drug with abuse potential. Of course, even if it were possible to prevent any diversion of drugs manufactured for medical use, decades of street use during a total ban of the drug is testament to the fact that legally manufactured MDMA for precription use would be a drop in the bucket of illegally manufactured MDMA.

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Oakland, Calif: Why not legalize all hallucinogenic drugs (e.g. LSD, MDMA, THC, etc)? Where does the public harm come from these drugs if they were more freely available? And wouldn't there be a lot less harm if the use of heroin, etc. were NOT criminalized?

Tom Shroder: The issue of decriminalization of any potentially harmful drug is part of a raging debate that will continue no doubt for years. It's true that the Multidisciplinary Association for Psychedelic Studies (MAPS), the organization primarily responsible for the resurgence of scientific study of psychedelics, is strongly opposed to the drug war in general. But most of the physicians and researchers who are very keen to see if psychedelics can live up to their alleged promise definitely do NOT want their work to get tangled up in the bottomless, highly politicized battle over drug policy. They want to do their work in strict accordance with all current drug laws.

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Youngstown, Ohio: Thanks for your story, as a cluster headache sufferer it was very much appriciated the positive spin on this treatment.

Tom Shroder: Thanks. You bring up an interesting aspect of psychedelic research I didn't focus on, which is that LSD has an established anecdotal history of successfully treating horribly painful and debilitating cluster headaches. Its (still-illegal) use for that purpose has spread in a web-based community of people who suffer from the condition, and attest to the drug's effectiveness in stopping, and disrupting the cycle of extreme headaches. There is a current proposal, not yet approved, to do clinical trials to test that idea.

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Los Lunas, NM: I enjoyed your article on MDMA for treating PTSD. Thank you for showing the positive side of entheogenic treatments for a number of very difficult to treat syndromes. Having successfully used these types of treatments for cluster headaches, I look forward to the day that we can all access these medicines, legally.

Tom Shroder: To the same point;

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Asheville, NC.: Are there other illnesses with which MDMA might be useful in treating?

Tom Shroder: There is a clinical trial starting up at Harvard's McLean hospital testing the use of MDMA-assisted therapy in the treatment of acute anxiety in patients with advanced cancer. Obviously, if this shows promise, it raises the possibility of treatment for a variety of anxiety disorders. The idea of using MDMA for both PTSD and end-of-life issues arose from actual clinical use during the period before the drug was illegal, when a community of psychedelic therapists used it extensively with their patients. Since at least one aspect of MDMA-therapy appears to work differently than a lot of psychiatric drugs in the sense that it doesn't alleviate symptoms directly, but through helping the patient reach psychological insights, you could imagine that it might also have some potential for any disorders whose origin are rooted in life experience.

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Lombard, Ill.: Hello Tom,

I just wanted to thank you for the positive and honest article on MDMA. Articles such as this may not change outdated laws or callous minds, but it can improve, and in some cases save, the lives of individuals that are made aware of this type of research.

Thank you for your honesty and integrity in reporting that there is hope for those that conventional medicine seems perfectly willing to cast aside.

Bob W

Tom Shroder: Thanks for the kind words. One thing that seems clear to me is that Dr. Mithoefer and others engaged in this research only want a chance to test the potential medical uses of MDMA and other psychedelic drugs using good science to evaluate both the potential benefits and the potential risks.

Tom Shroder: On that point, I got this from Thomas B. Roberts, Ph.D. co-editor of "Psychedelic Medicine: New Evidence for Hallucinogens as Treatments"

Dear Mr. Shroder,

"I hope readers of your article and our books realize we support legal medical and scientific research into the medical uses of psychedelics. We do not suggest self-medication. This perspective is typical of the second wave of psychedelic researchers. If fact, it is likely that most uses of these drugs will be in the presence of trained professionals, (similar in that way to anesthetics) not prescribed for out-of-clinic use."

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Munich, Germany: Is a psychedelic drug the same thing as a hallucinogenic drug?

When I read that LSD-like drugs can hurdle psychic roadblocks, open doors of communication and produce emotional closeness and euphoria, it sounds like the right stuff for therapeutic use. But what exactly does altered consciousness have to do with psychotherapy?

Tom Shroder: Yes, but the terminology is somewhat imprecise, since MDMA rarely produces any true hallucinations.

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Blacksbug VA: Tom,

I enjoyed reading "The Peace Drug" and I thought it was well-balanced. Having observed various aspects of the MDMA story over 30 years, what is your opinion on where it is going from here? For the sake of argument, let's assume studies demonstrate impressive efficacy in assisting psychotherapists to help treat PTSD. Can you see, for example, specialized clinics/training centers sprouting up across America in 10 years? Do you see the military (here and elsewhere) "buying in" to MDMA-assisted psychotherapy as an option for treating soldiers with PTSD? Or will MDMA remain "fringe" at best?

Tom Shroder: I think the key, as always, is what the scientific studies demonstrate. If the current phase II studies have very positive results, which they certainly appear headed for, and a many-times larger phase III study, with hundreds of subjects and dozens of therapists all across the country also demonstrated -- for the sake of argument -- spectacularly positive results, then yes, I do believe that MDMA would become part of the treatment arsenal for PTSD. If it works as some hope, the fact that very limited use of the drug -- a handful of sessions -- can effect lasting change in the underlying psyche of PTSD sufferers and untangle the knots that cause their symptoms would make it an extremely appealing option. But it's a long way from a phase II clinical study and that eventuality. There are very many drugs that appear promising in phase II studies only to falter later on.

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New York, NY: MDMA will be almost certainly be invaluable to thousands of people some day, but it does break my heart to see these initial guinea pigs getting the short end of the stick, with no chance of continuing treatment. I guess it's better than nothing, although the relapse rate over the years might end up being quite high for them -- making the study look bad -- when all it would take would be one or two treatments every other year for several years or so and they might be cured.

Is there any provision in Dr. Mithoefer's study to follow these people over the years, to observe how they fare? Or are they waiting until Phase III trials to do that sort of thing?

Tom Shroder: A followup on the subjects who have been through the study so far is happening now, which means that some subjects have been post-treatment for more than three years, Donna Kilgore in the story was subject 1, so she's been the longest. And she was only allowed two treatments -- the study was since modified to allow three MDMA treatment sessions.

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Amherst, Ohio: The VA for years has been looking for a miracle cure for PTSD to erase the money spent for PTSD claims, do you fear as I do this might be looked at for just that purpose?

Tom Shroder: First of all, the VA and the Pentagon have had nothing to do with this research. But to the larger point of your question, it seems to me a backward way of looking at it: The only reason this treatment would save the VA money would be if it actually works. Then that would be a very good thing, no? PTSD, as it became clear to me when I was interviewing the subjects mentioned in the story, is a particulary cruel disorder. When Donna Kilgore told me that she could put her finger on her arm and feel like she was touching a corpse, I nearly wept for her right then and there. So making them feel whole again is a very good thing indeed. And Spending less tax money on people who are cured -- also very good thing..

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No VA: I'm curious to know if there are any follow-up studies on the long term effects of the use of these drugs? Especially with large numbers of young soldiers returning from Iraq and Afghanistan, we have to ask not just if the benefits of these drugs will outweigh the suffering in the short term, but also if they will need long term treatment, and what that might mean for their health.

Tom Shroder: This is an important issue, and it emphasizes what Dr.Mithoefer always cautions: Phase II trials are very early in the process of determining if a drug is beneficial. In the case of MDMA, if it proves effective, then it will take years to determine the best way to use it -- and how treatment with MDMA will unfold over the years. Will some people be cured outright and forever? Will periodic MDMA sessions be necessary to maintain the benefits? Could unforseen problems arise with long-term therapeutic use? None of these questions have even begun to be answered.

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Washington, DC: I know three people who seem permanently damaged from MDMA usage. My friend J can't get upset at anything- not a friend's traffic death, not the actions of the president, not with his parents- his whole attitude is one big "no worries man" or "it's all good." The guy still works at the same store at age 30 with no house and no girlfriend while the rest of us struggled to buy houses, to make relationships work, get married and now raise kids. Meanwhile J says we "worry too much" about our medical or law school, retirement and careers and plays Super Mario all night. He has a brain and can talk about movies and books, but he no longer has emotions. Is this the life that MDMA creates? No strong highs or lows, just a long string of average with no interests or efforts. If so then why would people suggest this mind-altering drug is beneficial?

Tom Shroder: Good and important question. I don't think anybody is arguing that chronic longterm abuse of this or any drug isn't dangerous. It's very well established in animal studies that large and repeated doses of MDMA can create lasting damage to serotonin receptors in the brain. It's also pretty clear that long-term chronic use of MDMA in humans is associated with some diminishment of mental functioning. It's important to remember that in the human studies, it's very difficult to separate out the effect of the MDMA abuse from the abuse of other drugs that is common in that population, or the other personality disfunctions that may lead a person into chronic drug abuse in the first place. But the use of MDMA as a clinical drug is a very different matter. The FDA would never have approved the current study if there hadn't been clear evidence that clinical doses given in clinical conditions caused no observable damage. That's not saying it is risk free -- no drug is -- but if clinical trials prove that the drug can alleviate PTSD in most people, then that would likely be a risk worth taking. It's really the same calculus that goes into the assessment of the use of any medicine.

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DeKalb, Ill: In response to the question from Munich about why psychedelics work:

Psychoactive drugs permit the mind/brain to function using different patterns of thinking, emotions, perception, and behavior. In this way they are similar to computer programs; when one installs a new computer program, a computer can do new things with information. Analegously, when the brain-mind installs a new program (new mindbody state) it can do new things -- process thoughts, emotions, and percpetions differently.

Tom Shroder: This is an interesting theory. All the researchers I spoke to, however, said that it was completely unknown exactly why psychedelic drugs produce the experiences they do. That's something that will take years and years to understand, I would wager.

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Albany, NY: What do you think is the main source of opposition to the further exploration of MDMA as a therapeutic tool?

Tom Shroder: I think it would be from people who fear that "legitimizing" MDMA as a medicine would encourage people to abuse it. The counter argument has a couple of aspects: First, you could make the same argument about many, many valuable drugs -- morphine being an obvious example. But as one of the country's leading PTSD researchers, Roger Pitman of Harvard, says, important medical uses should trump any such fears. Plus demonizing the drug has not prevented widespread abuse in the first place.

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Maryland: Just wondering. It is illegal to sell or buy drugs, but there is no laws against using drugs???

And an ex-addict is disabled under the ADA. Those currently using the drugs is not disabled.

Tom Shroder: Oh, it is definitely illegal to possess MDMA.

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Rockville, Md: The cold, hard reality is that, for the thousands of people who have gone to clubs, nightclubs, raves, parties, concerts, festivals and other events where people have taken ecstasy, the reality is very simple: This is a horrible, terrible, screwed-up drug that causes a multitude of horrible, serious, messed-up health problems in all users. Many people have seen the very serious, very real, negative effects of this drug, and everyone knows that it should not be legalized, people should not be using it, and it can literally ruin many peoples' lives. If you talk to someone whose life was ruined by ecstasy, and there are many, your view will quickly change. This is not a light issue. The same goes for pot, coke, heroin, PCP, acid, crack, ice, hash, other club drugs and every other mind-altering substance. There are alternatives to just legalizing illegal drugs and creating dangers where they don't need to be created. There are many alternatives. And the research on the severe, serious dangers of illicit drugs is pervasive, and undebatable.

Tom Shroder: This is a similar point of view to an earlier comment, and again, there is no doubt that uncontrolled used of MDMA or any psychedelic drug can be very dangerous.

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Dunn Loring, VA: To Tom Shroder:

On p. 28 you said "MDMA exertt a stress on the body similar

to strenuous exercise and increases core body temperature.:

My question is really for the researchers, but to get a start I

would ask you, may exercise have a similar effect as MDMA?

My experience is that with exercise, I get some of the

benefits you describe as from MDMA. Without exercise I

have trouble coping. Another example is the "runner's high"

which seems to simulate the effects of MDMA. Has any

research been done on the connection?

Tom Shroder: Very interesting observation. In fact, the non-drug technique of holotropic breathwork runs (haha!) with your idea, by using physical exertion in the form of hyperventilation and music and setting to create a non-drug induced altered state of consciousness. One of the background theories behind psychedelic therapy is that it is in fact the altered state of consciousness, not the drug, that creates the healing.

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Blacksburg, VA: I have a comment about terminology. This may be "inside baseball" but there is scientific evidence to support the hypothesis that MDMA is chemically/pharmacologically somewhat different from psychedelics/hallucinogens. Similarly, MDMA is not simply a stimulant. It may represent a new class of drugs. Would you speak to that?

Tom Shroder: Yes, there are people who think of MDMA as a new cass of drugs, an entheon (don't count on that spelling!) Chemically, it is closely related to BOTH methamphetamine and mescaline, two drugs with drastically different effects on the mind and body, and not remotely in the same class in that sense.

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Virginia: What about studies done in other countries?

Tom Shroder: As I mention in the article, there are ongoing studies in Switzerland and Israel, plus there is treatment of drug and alcohol addiction using psychedelic drugs in Canada.

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DeKalb, Ill.: Since most of the proposed medical uses of psychedelics are for use in a clinic under the supervision of a professional (similar in this way to anesthetics) the problem of diversion is minimal.

Tom Shroder: A comment on an earlier question.

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Austin, Tex: In response to several posters today, I think it is important to remember that a good portion of the negative side effects experienced by illegal users of MDMA are caused by badly manufactured street doses of ectasy. Dealers have been known to spike the pills with all sorts of nasties. Legal, pure MDMA would seemly not be subject to many of these issues.

Tom Shroder: On the street, you just don't know what you are getting for your $20 (or whatever). Some of the stuff they put in illegaly Ecstasy pills is harmless filler, but some is far from hamless. It's also noteworthy that illegal users of Ecstasy might also tend to use a host of other illegal drugs. The whole lifestyle of illegal drug use is harmful in itself,as well.

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Washington, DC: Your article said that 20% of the VA's payments were for PTSD. That's a huge drain on resources. Why isn't the VA looking into other "fringe" treatments? If 20% of my budget went to, say, heating my home, it wouldn't take me long to start looking at unconventional products.

Tom Shroder: Good point. I liked what Dr. Pitman said about that: If there's a 5% chance that this works -- if there's a ONE percent chance -- we need to pursue it, because the treatments we now have for this horrible disorder just aren't getting the job done in far too many cases.

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Dunn Loring, VA: I have heard that propranolol (which I experienced as a

heart medication) has been used to relieve the emotional

burden of painful memories foe PTSD. May that drug have

a similar effect or utility? One issue, I believe, some have is

that our memories are who we are. without their emotional

component, are memories really the same, or equalivent?

Tom Shroder: I'm not sure if that's the same drug that Dr. Pitman is researching -- but it sounds similar at least. He is looking at a drug that actually inhibits the protein essential to the formation of memories stored in the brain. When given to people immediately after suffering a trauma, it appears to diminish the possibility that PTSD will result. But since every time the brain accesses a memory, it has to, in effect, create the memory anew to restore it, it's possible that drug could be used in conjunction with reexperiencing therapy -- the memory is called to mind, but when the brain trys to recreate the memory to put it back in storage, it can't do it. This is based on my understanding of Pitman during a phone conversation, so please don't take this as expert tedtimony.

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Lexington, Ky.: Hiya Tom. Just wanted to give a wave from the ibogaine/ayahuasca community here in the states. Although there may never be a 'magic bullet' for healing psychic traumas, theraputic psychedelic experiences can and are producing long lasting and meaningful effects as immediate as the hip replacement example you made reference to. The world should know that not only MDMA, but many other compounds in underground use can provide what can only be described as a paradigm shift in one's life. Whether for or against, it's simply impossible to have an objective opinion on these substances without experiencing firsthand the positive effects these kinds of treatments can provide.

Tom Shroder: This underscores the fact that there is a fairly large and active community of people who believe in the value of therapeutic use of psychedelic drugs. I would say that I don't agree entirely with the idea that one has to experience the drug's effects to have an objective opinion about it. That's the wonderful thing about science -- you can really test ideas in a very non-subjective way that will determine, ultimately, whether something works, or doesn't work.

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Ridiculous example:"I know a person who used MDMA and they're damaged" -- come now, you probably know alcoholics who are permanently brain-damaged, too. Does that mean we should go back to prohibition? And ignore all the studies supporting MODERATE alcohol consumption?

Thanks for your terrific article and the further information in this chat, Tom.

Tom Shroder: A response to an earlier post.

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Tom Shroder: Thanks for so many excellent questions. Time to go back to my day job.

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